Objectives: Data describing the incidence and the risk factors for surgical interventions in pediatric Crohn`s disease (CD) is scarce and inconsistent. Our aim was to describe the rates of intestinal surgery and to identify associated risk factors in a large cohort of children with CD.
Methods: Medical charts of 482 children with CD from the Schneider Pediatric Inflammatory Bowel Disease (SPID) cohort who were diagnosed between 1981 to 2013 were carefully reviewed retrospectively.
Results: Median follow-up time was 8.6 years (range, 1-30.5). One hundred forty three children (29.7%) underwent intestinal surgery. Kaplan – Meier survival estimates of the cumulative probability of CD-related intestinal surgery were 14.2% % at 5 years and 24.5% at 10 years from diagnosis. Of these 14% needed more than one surgery. Multivariate Cox models showed that isolated ileal disease (HR 2.39, P = 0.008), complicated behavior (HR 2.44, P < 0.001) and higher severity indices at diagnosis including Harvey-Bradshaw (HR 1.06, P=0.009) and short pediatric Crohn`s disease activity index (PCDAI) (HR 1.02, P=0.001) were associated with increased risk for surgery. Age, gender, family history of CD, early introduction of immunomodulators or diagnosis prior to the year 2000 did not affect the risk of bowel surgery.
Conclusions: Ileal location, complicated behavior, higher disease activity indices at diagnosis are independent risk factors for bowel surgery while early introduction of immunomodulators and diagnosis during the "biologic era" are not associated with diminished long-term surgical risk.
